Video Lending Library Request Form

Date video requested:

Please send my rental request to:

Name:

Organization Name:  

Address:  

City:    State:        Zip:

Email: Phone:

Rental Agreement Terms and Conditions:

• Copying, duplicating, cutting or altering the videos is in violation of copyright laws
• Videos may not be loaned to another individual, group or organization
• Videos must be returned by the due date, and returned in good condition as when the videos were received.
• Renting party is responsible for any loss of or damaged videos and the renting party may be responsible for the cost to replace the lost or damaged video(s).
• Videos may be rented for a period of 2 weeks, the rental period begins on the day the videos is received by the renting party.
• Videos must be returned by insured mail and the cost of the return to be paid for by the renting party.
  

Signature of Authorized Renter:

Date:
            

Contact Shelly Hegerle, HR Specialist
(701) 221-9824 or shelly@communityhealthcare.net
with questions or comments.